2.1 Challenges in LMICs

Rapid growth in demand for animal protein has accelerated food animal production in LMICs. To meet this demand, food animal production in LMICs is shifting from small-scale landholders to large-scale and intensive farming. Small-scale farms that are expanding to intensive enterprises, and many existing intensive farms often use antimicrobials to keep animals healthy, maintain productivity and maximise economic returns.

Studies have predicted that by 2030, global antimicrobial consumption (AMC) in animals will increase by 67% from 2010 levels. By 2030, the five countries with the largest share of global AMC in food animal production will be China (30%), the United States (10%), Brazil (8%), India (4%) and Mexico (2%). It is also predicted that of the 50 countries with the largest amount of antimicrobial use in food animals in 2010. Five of these, shown in Figure 5, will have the greatest projected percentage increase – Indonesia (205%), Myanmar (202%), Nigeria (163%), Peru (160%) and Philippines (157%) – in AMC in livestock by 2030 (Van Boeckel et al., 2015).

Figure 5 How the worldwide consumption of antimicrobials in animals is set to increase. (A) Largest five consumers of antimicrobials in livestock, 2010; (B) Largest five consumers of antimicrobials, 2030; (C) Largest increase in AMC, 2010–30; (D) Largest relative increase in AMC, 2010–30. CHN = China; USA = United States; DEU = Germany; IND = India; MEX = Mexico; IDN = Indonesia; MMR = Myanmar; NGA = Nigeria; PER = Peru; PHL = Philippines (Van Boeckel et al., 2015).

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A bar graph depicting the predicted increase in worldwide consumption of antimicrobials in animals between 2010 and 2030. Section A of the graph shows usage levels in 2010 of the largest five consumers of antimicrobials in livestock (India, Germany, Brazil, USA and China). Section B shows the largest five consumers of antimicrobials in livestock predicted for 2030 (India, Mexico, Brazil, USA and China) and shows an increase of 67% when compared with section A. Section C shows the countries with the largest increases in antimicrobial consumption in livestock 2010-2030 (China, Brazil, India, USA and Indonesia). Section D shows the largest relative predicted increase in antimicrobial consumption for livestock from 2010-2030 (Indonesia, Myanmar, Nigeria, Peru, Philippines).

Figure 5 How the worldwide consumption of antimicrobials in animals is set to increase. (A) Largest five consumers of antimicrobials in ...

The inability to control access to antimicrobials is one of the biggest challenges facing many LMICs when responding to AMR.

In LMICs, farmers often do not have ready access to veterinary expertise, or they cannot afford their services. In such scenarios, farmers turn to other sources to access antimicrobials. Agrovet shops, open markets, online stores and feed mills fill this gap. Selling antimicrobials is an important source of income for non-veterinary services, and often little is done by governments to regulate their activities.

Access to high-quality antimicrobials is seen as a critical factor in ensuring effective management of animal health and food safety. Conversely, substandard or counterfeit antimicrobials, where the concentration of active ingredients is below therapeutic levels or a different active ingredient is used to what is on the label, are ineffective and promote AMR development.

LMICs face challenges with substandard or counterfeit antimicrobials in both human and animal health settings. An evaluation by the OIE of national animal health systems in more than 130 countries showed that many LMICs either do not have appropriate legislation or have no legislation at all to regulate the import, manufacture, distribution and use of antimicrobials in animals. The OIE also found that antimicrobials were adulterated in many of these countries (OIE, 2015).

The challenge for us all is to understand how it is possible to reduce overuse and misuse of antimicrobials, including access to substandard drugs and sub-optimal dosing, especially in LMICs.

For many LMICs, where challenging farming environments prevail, antimicrobials are perceived as necessary to prevent and control animal diseases. However, many farmers have a limited understanding of AMR and AMS. Easy access to antimicrobials via non-veterinary channels poses a major barrier to adopting antimicrobial stewardship principles. Improving the regulatory capacity of LMICs to control the antimicrobial supply chain and increasing the number of veterinarians and veterinary paraprofessionals is essential if farmers are to have access to safer antimicrobials and the best advice on their appropriate use.

Government investment in regulatory systems and in increasing the number of veterinarians and veterinary paraprofessionals servicing farms is critical to addressing the challenges of AMR in LMICs. Intervention strategies aimed at driving behaviour change and boosting knowledge of prudent use of antimicrobials at the farm level will also help. A ‘bottom-up’ approach to education on prudent antimicrobial use can have the benefit of spreading knowledge and new practices to farmers and other stakeholders such as agrovet employees.